Validation of exophthalmos magnetic resonance imaging measurements in patients with Graves’ orbitopathy, compared to ophthalmometry results

Purpose: Although assessment of the orbital structures using magnetic resonance imaging (MRI) is well described in the literature, there is no consensus as to which measurement method is the most useful in exophthalmos assessment. The aim of the study was to correlate 2 MRI methods of exophthalmos measurement with exophthalmometry results and to determine a proper technique of exophthalmos measurement. Material and methods: Fifty-four patients (108 orbits) with exophthalmos in the course of Graves’ orbitopathy were enrolled in the study. Two measurements on axial T2W orbital MRI images were performed by 2 independent radiologists: the distance from the interzygomatic line to the anterior surface of the globe (AD) and the distance from the interzygomatic line to the posterior sclera (PD). Within 4 weeks, an exophthalmometry was performed by an ophthalmologist using a Hertel exophthalmometer. The inter-observer variation was assessed using the Pearson correlation coefficient. Values were presented as mean and standard deviation, and the differences in values were explored with Student’s t-test. Results: The mean AD measured on MRI by the first observer was 20.6 ± 3 mm, and 20.6 ± 2.9 mm by the second observer. PD values were 2.9 ± 2.8 mm and 3.4 ± 2.8 mm, respectively. The mean exophthalmometry result was 21 ± 3.3 mm. The correlation was very high between observers for AD measurements (r = 0.98, p = 0.01) and high for PD measurements (r = 0.95, p = 0.01). AD measurements on MRI and exophthalmometry results were strongly correlated (r = 0.9, p = 0.01). Conclusions: The AD measurement has better reproducibility and is directly correlated with Hertel exophthalmometry. This method could be sufficient in routine practice

DIFFERENCES IN THE DYNAMICS OF CHANGES IN THE CONCENTRATION OF KYNURENIC ACID IN THE BLOOD SERUM OF DEPRESSED PATIENTS TREATED WITH ELECTROCONVULSIVE THERAPY

Background: Nowadays, depression is a serious clinical problem, as the prevalence of its various forms increases and there are growing numbers of patients with severe forms of depression and treatment-refractory depression. Depressed patients have been observed to have decreased levels of kynurenic acid (KYNA), which is the only endogenous antagonist of ionotropic N-methyl-Daspartate (NMDA) receptors. The aim of this study was to identify subgroups of patients differing in the dynamics of changes in KYNA concentration during electroconvulsive therapy (ECT). Subjects and methods: The study included 32 patients with an ICD-10 diagnosis of a major depressive episode receiving ECT treatment and 48 healthy volunteers. Blood serum KYNA concentrations were determined using HPLC-based methods, and clinical assessment was performed using the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impressions (CGI) Scale. Results: Three subgroups of patients with depression were identified which differed in baseline KYNA levels and in the dynamics of changes in blood serum KYNA concentrations during and after ECT. Conclusions: The largest number of patients with clinical improvement (83%) was observed in the subgroup with significantly lower pre-treatment, treatment and post-treatment KYNA concentrations than those determined in the control group. This subgroup of patients also showed the lowest dynamics of changes in KYNA concentrations during ECT. Clinical improvement was observed in 75% of depressed patients who had insignificantly lower pre-treatment levels of KYNA and slightly higher levels of this acid after 6 and 12 ECT sessions than controls. The smallest number of patients with clinical improvement (50%) was observed in the subgroup of patients who had similar pre-treatment and treatment concentrations of KYNA to controls and whose post-treatment concentrations of KYNA were significantly lower than those of healthy individuals

Endolymphatic Hydrops, Evaluated Using 3T MRI in Patients with Clinically Confirmed Meniere Disease

Ménière’s disease (MD) is characterised by intermittent episodes of vertigo with fluctuating sensorineural hearing loss, tinnitus and aural fullness. Despite numerous studies, the etiology of this disorder remains poorly understood and thus diagnostic criteria are mainly clinical. Development and progress in magnetic resonance imaging (MRI) techniques, in 2007, has enabled visualisation of endolymphatic hydrops, which was the milestone achievement. We present two cases of patients with clinically confirmed MD with a set of audiological, otoneurological examinations and MRI performed. Structures of the inner ear were visualized using contrast-enhanced MR imaging after a 4-hour delayed intravenous gadolinium administration. The cochlea and vestibule were evaluated separately and classified using Barath grading scale. Endolymphatic hydrops in the clinically affected ears were confirmed using MRI. Due to disabling and intractable MD, a decision about vestibular neurectomy was made

Zastosowanie badania rezonansu magnetycznego ucha wewnętrznego w diagnostyce choroby Ménière’a

Choroba Ménière’a charakteryzuje się występowaniem napadowych wirowych zawrotów głowy, którym towarzyszy szum uszny i/lub uczucie pełności w uchu oraz fluktuacyjny niedosłuch odbiorczy. Pomimo wielu badań, etiologia tej choroby pozostaje nieznana, jednak uważa się, że u podłoża schorzenia leży rozszerzenie przestrzeni endolimfatycznych ucha wewnętrznego, zwane „wodniakiem śródchłonki”. Rozwój techniki badania rezonansu magnetycznego (MR) w ostatnich latach umożliwił przyżyciowe obrazowanie wodniaka endolimfatycznego u pacjentów z objawami choroby Ménière’a. Wizualizacja przestrzeni płynowych ucha wewnętrznego dokonywana jest po zastosowaniu kontrastu gadolinowego podawanego do jamy bębenkowej lub dożylnie. Ocena zaawansowania wodniaka jest możliwa dzięki selektywnemu przenikaniu środka kontrastowego do perylimfy, podczas gdy endolimfa pozostaje widoczna jako ubytki w zakontrastowaniu. Wśród stosowanych obecnie radiologicznych klasyfikacji oceny zaawansowania wodniaka możemy wyróżnić skale opisowe, półilościowe oraz objętościowe. Metody te wciąż poddawane są modyfikacjom mającym na celu zwiększenie ich czułości oraz swoistości. Liczne prace opisują korelacje objawów klinicznych i wyników badań audiologicznych oraz otoneurologicznych z zaawansowaniem wodniaka. MR ma zastosowanie także w diagnostyce pacjentów o niepełnym i nietypowym przebiegu choroby Ménière’a. Podczas leczenia kontrolne badania MR pozwalają na ocenę skuteczności poszczególnych metod terapii pod kątem zaawansowania zmian i dalszego przebiegu choroby w uchu wewnętrznym

Wodniak śródchłonki potwierdzony przy użyciu 3-teslowego skanera MR u pacjentów z obrazem klinicznym choroby Ménière’a

Choroba Méniere’a charakteryzuje się występowaniem napadowych zawrotów głowy z towarzyszącym fluktuacyjnym niedosłuchem odbiorczym, szumami usznymi oraz uczuciem pełności w uchu. Pomimo wielu badań, etiologia choroby pozostaje nieustalona, a jej diagnoza opiera się w głównej mierze na obrazie klinicznym, który charakteryzuje się dużą zmiennością osobniczą i fluktuacyjnym przebiegiem. Możliwość obrazowania ucha wewnętrznego metodą rezonansu magnetycznego po raz pierwszy została opisana w 2007 roku i okazała się znacznym przełomem w diagnostyce wodniaka endolimfatycznego. Prezentujemy opis dwóch przypadków pacjentów z obrazem klinicznym sugerującym chorobę Méniere’a, u których został wykonany pakiet badań audiologicznych, otoneurologicznych, a także rezonans magnetyczny ucha wewnętrznego. W badaniu obrazowym, struktury przedsionka oraz ślimak zostały ocenione po czterech godzinach od podania podwójnej dawki kontrastu gadolinowego dożylnie za pomocą skali zaproponowanej przez Baratha. U opisywanych chorych potwierdzono obecność wodniaka śródchłonki po stronie objawów klinicznych w badaniu MR. Z uwagi na znaczne zaawansowanie kliniczne choroby, opisywani pacjenci zostali zakwalifikowani do chirurgicznego leczenia poprzez przecięcie nerwu przedsionkowego z dostępu przez dół środkowy czaszki

Magnetic resonance imaging of the inner ear in the diagnostics of Ménière’s disease

Ménière’s disease is characterized by sudden episodes of vertigo accompanied by tinnitus and/or feeling of fullness in the ear as well as fluctuating sensorineural hearing loss. Despite numerous studies, the etiology of this disease remains unknown. However, the enlargement of the inner ear’s endolymphatic spaces, referred to as endolymphatic hydrops, is considered the underlying condition. Thanks to recent advances in magnetic resonance (MR) technology, it is now possible to obtain in vivo imaging of endolymphatic hydrops in patients presenting with Ménière’s disease symptoms. Visualization of the inner ear fluid compartments is achieved after gadolinium contrast is administered into the tympanic cavity or via the intravenous route. Evaluation of endolymphatic hydrops is possible as the contrast agent selectively penetrates the perilymph, and endolymph is visualized as contrast defects. The currently used radiological hydrops grading systems include qualitative, semi-quantitative, and volumetric scales. The methods are subject to ongoing modifications to increase their sensitivity and specificity. Numerous studies describe correlations between clinical symptoms and audiological and otoneurological examination results with the endolymphatic hydrops grade. MRI is also applicable in patients’ diagnostics with an incomplete or atypical course of the Ménière’s disease. In the course of the treatment, follow-up MRI scans enable assessing individual treatment modalities’ efficacy in terms of the severity of lesions and the further course of the disease within the inner ear

Reliability of Endolymphatic Hydrops Qualitative Assessment in Magnetic Resonance Imaging

The study aimed to compare the consistency of MRI interpretation of endolymphatic hydrops qualitative assessment of inner ear structures performed by independent observers. MRI with a delayed post-contrast 3D-FLAIR sequence was performed to visualize EH in patients suspected of having or diagnosed with MD. The scans were analyzed independently by three observers. In total, 220 ears were evaluated and, of these, 75 had definite MD, five probable MD, 67 with other Menieriform symptoms, and 73 were asymptomatic. Significant differences in cochlear endolymphatic hydrops (CoEH) grading between all observers were observed. On the Barath scale of vestibular endolymphatic hydrops (VEH), differences were found between the radiologists and otorhinolaryngologist in grading. No differences were noted in VEH on the Bernaerts scale and increased perilymphatic enhancement. Our study showed that evaluation of vestibular endolymphatic hydrops is repeatable between observers and easy to learn. It proved that Bernaerts’ modification increased the sensitivity of EH diagnosis. Both parameters, CoEH and VEH, may serve as a differentiation method of EH from normal ears. The distinction between normal and hydropic ears is much easier to perform than EH grading. Therefore, it may be used to diagnose MD rather than EH staging

Rare proliferative and inflammatory pathologies localized in the temporal bone – a review of the literature

Introduction: Proliferative-inflammatory pathologies may occupy the temporal bone, resulting in: hearing loss, vestibular dysfunction, and neuropathies from cranial nerve compression. Although their occurrence is episodic, the appropriate diagnostic procedure is extremely important to achieve expected therapeutic effect. Aim: The aim of study was characterization of selected proliferative-inflammatory pathologies that may occupy the temporal bone: fibrous dysplasia, inflammatory pseudotumor, osteoradionecrosis, and presentation of diagnostic methods for the differentiation of these diseases as well as discussion on appropriate therapeutic options. Fibrous dysplasia (FD) is a slowly progressive, benign bone disorder of unknown etiology characterized by abnormal proliferation of fibrous tissue. Inflammatory pseudotumor (IPT) is a rare, non-malignant inflammatory process of unknown etiology, characterized by connective tissue proliferation and infiltration of inflammatory cells. Osteoradionecrosis of the temporal bone (TB-ORN) is a rare but potentially fatal complication of radiotherapy for head and neck cancer. Results: Due to the similarity of symptoms with typical inflammatory conditions of middle ear (pain, otorrhea, hearing loss), selected disorders may be a dilemma regarding the diagnosis and proper further treatment. The clinical examination is mandatory, however radiological imaging may demonstrate the presence of specific changes and direct the diagnosis. The computed tomography (CT) of fibrous dysplasia shows the abnormal organization of the bone structure. Magnetic resonance (MRI), as the most sensitive for inflammatory pseudotumors, visualizes inflammatory infiltration in soft tissues. The CT of temporal bone identifies the erosion in the course of osteoradionecrosis. However in all cases the final diagnosis may be establish using histopathological examination and after exclusion of the neoplastic process

Rzadkie patologie rozrostowo-zapalne zlokalizowane w kości skroniowej – przegląd piśmiennictwa

Wprowadzenie: Patologie rozrostowo-zapalne mogą zajmować kość skroniową, powodując różnorodne objawy, zależne od ich umiejscowienia: niedosłuch, dysfunkcję przedsionkową i neuropatie spowodowane kompresją nerwów czaszkowych. Jakkolwiek ich występowanie jest rzadkie, istotne jest odpowiednie postępowanie diagnostyczne, które skutkuje wdrożeniem właściwej terapii. Cel: Celem pracy była charakterystyka kliniczna i przegląd metod diagnostycznych oraz zaleceń terapeutycznych w wybranych patologiach rozrostowo-zapalnych kości skroniowej: dysplazji włóknistej, inflammatory pseudotumor, osteoradionekrozie. Dysplazja włóknista (fibrous dysplasia) jest powoli postępującym, łagodnym zaburzeniem kostnym o nieznanej etiologii, charakteryzującym się nieprawidłową proliferacją tkanki włóknistej. IPT (inflammatory pseudotumor) to nienowotworowy proces zapalny o nieznanej etiologii, charakteryzujący się proliferacją tkanki łącznej i naciekiem komórek zapalnych. Osteoradionekroza kości skroniowej (TB-ORN) to rzadkie, ale potencjalnie śmiertelne powikłanie leczenia radioterapią nowotworów głowy i szyi. Wnioski: Ze względu na podobieństwo objawów z powszechnymi patologiami zapalnymi ucha środkowego (bóle, wycieki z uszu, niedosłuch) prezentowane rzadkie schorzenia mogą stwarzać problem diagnostyczny i terapeutyczny. Dokładne badanie kliniczne jest niezbędne, ale poszerzenie diagnostyki o badania obrazowe, może przyspieszyć ukierunkowanie diagnozy. W przypadku dysplazji włóknistej obrazy tomografii komputerowej (CT) wykazują charakterystyczną przebudowę struktury kostnej. W przypadku pseudoguzów zapalnych najbardziej czułym narzędziem wydaje się badanie rezonansu magnetycznego (MRI), które obrazuje nacieki zapalne w tkankach miękkich. Badanie CT kości skroniowej skutecznie uwidocznia ubytki i erozję w przebiegu osteoradionekrozy. W każdym z powyższych przypadków niezbędne jest wykonanie badania histopatologicznego w celu wykluczenia procesu nowotworowego

Detailed insight into magnetic resonance assessment of Ménière's disease : description of methodology and imaging findings in a case series

Purpose: The study aimed to describe the methodology and detailed interpretation of magnetic resonance imaging (MRI) in patients with Ménière’s disease (MD). Material and methods: MRIs were performed on a 3T scanner. The three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence 4 hours after a double dose of intravenous contrast was added to the standard MRI protocol in patients with clinically diagnosed MD. MRI findings of 7 patients with unilateral MD were analysed using 2 qualitative grading systems by Barath and Bernaerts. Results: In MRI, the following changes in the group of patients with MD were observed: lack of endolymphatic hydrops (cases #1 and #7), various grades of cochlear hydrops (cases #2 and #3), various grades of vestibular hydrops (cases #4, #5, and #6), endolymphatic hydrops herniation into the semi-circular canal (case #6), and more robust perilymphatic enhancement (case #7). Conclusions: In patients with MD, endolymphatic hydrops can be studied on MRI using 3D-FLAIR delayed post-contrast images. The qualitative grading system may be easily used in endolymphatic hydrops assessment. Recently described new radiological signs of MD such as increased perilymphatic enhancement of the cochlea and an extra low-grade VH may increase MD diagnosis sensitivity. MRI not only supports the clinical diagnosis of MD but also may help to understand its pathophysiology